title: Third ventriculostomy site as a neuroreceptorial area.
abstract: OBJECTIVE
  Endoscopic third ventriculostomy is an established method for treating hydrocephalus. The third ventriculostomy site is considered a safe area that can be disrupted during surgical endoscopic procedures. The question of the clinical consequences of an apparently unavoidable injury to the floor of the third ventricle has been sporadically addressed in the literature. The aim of this study is to describe our anatomical and operative findings during endoscopic procedures performed in fluorescent mode after intravenous fluorescein injection and address the possible role of fluorescein-enhanced visualization of the median eminence as an accessory tool in order to partially spare this functional structure when performing ventriculostomy.
  
  
  METHODS
  We prospectively administered intravenously 500 mg of fluorescein sodium in 12 consecutive endoscopic surgery cases. A flexible scope equipped with dual observation modes for both white light and fluorescence was used. Taking into account the position of the basilar apex and the need for a conveniently sized stoma, a perforation area was chosen and dilated using a Fogarty balloon, guided by fluorescein-enhanced visualization of the median eminence.
  
  
  RESULTS
  After a mean of 20 s in the fluorescent mode, the fluorescein enhanced the visualization of the median eminence-tuber cinereum complex. In our preliminary experience, by opening the stoma in the fluorescence mode, almost half of the visible median eminence surface can be spared from iatrogenic sacrifice.
  
  
  CONCLUSIONS
  Tailoring fluorescence-guided ventriculostomy is a feasible way of trying to preserve the median eminence and may have implications for the site and safety of this common surgical procedure.
authors.affiliation: Department of Neurosurgery, Treviso Regional Hospital, University of Padova, Pzza. le Ospedale Civile 1, 31100, Treviso, Italy, luca.basaldella@mac.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Basaldella
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiorindi
authors.forename: Francesco
authors.initials: F
authors.lastname: Sammartino
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caro
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Longatti
mesh_terms: D004724:Endoscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008473:Median Eminence / Q000473:pathology*; D061848:Optical Imaging; D020542:Third Ventricle / Q000033:anatomy & histology* / Q000601:surgery*; D014696:Ventriculostomy / Q000009:adverse effects* / Q000379:methods